Improved Accuracy of Percutaneous Biopsy Using “Cross and Push” Technique for Patients Suspected with Malignant Biliary Strictures

Purpose

Various methods have been used to sample biliary strictures, including percutaneous fine-needle aspiration biopsy, intraluminal biliary washings, and cytological analysis of drained bile. However, none of these methods has proven to be particularly sensitive in the diagnosis of biliary tract malignancy. We report improved diagnostic accuracy using a modified technique for percutaneous transluminal biopsy in patients with this disease.

Materials and Methods

Fifty-two patients with obstructive jaundice due to a biliary stricture underwent transluminal forceps biopsy with a modified “cross and push” technique with the use of a flexible biopsy forceps kit commonly used for cardiac biopsies. The modification entailed crossing the stricture with a 0.038-in. wire leading all the way down into the duodenum. A standard or long sheath was subsequently advanced up to the stricture over the wire. A Cook 5.2-Fr biopsy forceps was introduced alongside the wire and the cup was opened upon exiting the sheath. With the biopsy forceps open, within the stricture the sheath was used to push and advance the biopsy cup into the stricture before the cup was closed and the sample obtained. The data were analysed retrospectively.

Results

We report the outcomes of this modified technique used on 52 consecutive patients with obstructive jaundice secondary to a biliary stricture. The sensitivity and accuracy were 93.3 and 94.2 %, respectively. There was one procedure-related late complication.

Conclusion

We propose that the modified “cross and push” technique is a feasible, safe, and more accurate option over the standard technique for sampling strictures of the biliary tree.

     

Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy

Objectives

This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance.

Methods

Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples’ sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up.

Results

Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations.

Conclusions

Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy.

Key points

? CT-guided needle biopsy is a well-established diagnostic technique. ? Touch imprint cytological evaluation on site is helpful in improving quality of CT-guided biopsy. ? The rate of diagnosing malignant lymphoma specifically with cytological examination is relatively low. ? The rate of specific diagnosis of benign lesion in musculoskeletal regions is low.     

Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy

Purpose

The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI.

Materials and methods

Thirty newborn babies with hyperbilirubinemia at the gestational age of 38–40 weeks, diagnosed with acute neonatal bilirubin encephalopathy as a result of clinical findings were included in the study, and a further 24 newborn babies, whose ages, weights and gestational ages were equalized, were regarded as a control group. DWI was performed on both patient and control groups.

Results

When DWI apparent diffusion coefficients (ADC) of both neonatal bilirubin encephalopathy patients and the control group were compared, ACD values of neonatal bilirubin encephalopathy patients were found to be statistically significantly highly compared to that of the control group (p < 0.001). There was a significant correlation between bilirubin values and DWI findings (r = 0.41, p < 0.05).

Conclusion

The ADC measurement could be a promising parameter in detecting neonatal bilirubin encephalopathy.     

Fluoroscopic percutaneous brush cytology,forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction

Objectives

To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction.

Methods

A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated.

Results

A total of 232 interventions in 129 patients (70.8?±?11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6–48.7%), 42.7% (32.4–53.0%) and 55.8% (44.7–66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96.

Conclusion

Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction.

Key points

? Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy. ? Brush cytology may help to overcome “crush artefacts” from forceps biopsy. ? The cost per diagnosed malignancy may warrant tandem procedure in all patients.

     

Radiation Exposure in Biliary Procedures Performed to Manage Anastomotic Strictures in Pediatric Liver Transplant Recipients: Comparison Between Radiation Exposure Levels Using an Image Intensifier and a Flat-Panel Detector-Based System

Purpose

The aim of this study was to estimate radiation exposure in pediatric liver transplants recipients who underwent biliary interventional procedures and to compare radiation exposure levels between biliary interventional procedures performed using an image intensifier-based angiographic system (IIDS) and a flat panel detector-based interventional system (FPDS).

Materials and Methods

We enrolled 34 consecutive pediatric liver transplant recipients with biliary strictures between January 2008 and March 2013 with a total of 170 image-guided procedures. The dose-area product (DAP) and fluoroscopy time was recorded for each procedure. The mean age was 61 months (range 4–192), and mean weight was 17 kg (range 4–41). The procedures were classified into three categories: percutaneous transhepatic cholangiography and biliary catheter placement (n = 40); cholangiography and balloon dilatation (n = 55); and cholangiography and biliary catheter change or removal (n = 75). Ninety-two procedures were performed using an IIDS. Seventy-eight procedures performed after July 2010 were performed using an FPDS. The difference in DAP between the two angiographic systems was compared using Wilcoxon rank-sum test and a multiple linear regression model.

Results

Mean DAP in the three categories was significantly greater in the group of procedures performed using the IIDS compared with those performed using the FPDS. Statistical analysis showed a p value = 0.001 for the PTBD group, p = 0.0002 for the cholangiogram and balloon dilatation group, and p = 0.00001 for the group with cholangiogram and biliary catheter change or removal.

Conclusion

In our selected cohort of patients, the use of an FPDS decreases radiation exposure.     

A morphometric study of normal and varus knees

Purpose

The aim of the study was to investigate varus and normal knee morphologies to identify differences that may affect knee replacement alignment or design for varus knees.

Methods

Computed tomography scans of varus and normal knees were analyzed, and geometric shapes, points and axes were fit to the femur and tibia independently. These points were then projected in the three anatomical planes to measure the variations between the two groups.

Results

In the femur, varus knees had less femoral anteversion (p < 0.0001) and a larger medial extension facet (p < 0.05) compared with normal knees. In the tibia, the tubercle was found to be externally rotated in varus knees (12°), with a significant increase in the coronal slope (p = 0.001) and the extension facet angle (p = 0.002).

Conclusions

The study highlighted the differences and similarities found between the two groups, which raises awareness on changes required during surgical intervention and component placement or design for a varus knee. This is particularly relevant for the design of patient-specific instrumentation and implants.

Levels of evidence

Diagnostic study, Level III.     

Simultaneous integrated boost-intensity modulated radiation therapy for inoperable hepatocellular carcinoma

Purpose

The aim of this work was to evaluate the clinical efficacy and safety of simultaneous integrated boost-intensity modulated radiation therapy (SIB-IMRT) in patients with inoperable hepatocellular carcinoma (HCC).

Methods and materials

A total of 53 patients with inoperable HCC underwent SIB-IMRT using two dose-fractionation schemes, depending on the proximity of gastrointestinal structures. The 41 patients in the low dose-fractionation (LD) group, with internal target volume (ITV) Results Overall, treatment was well tolerated, with no grade >?3 toxicity. The LD group had larger sized tumors (median: 6 vs. 3.4 cm) and greater frequencies of vascular invasion (80.6 vs. 16.7?%) than patients in the HD group (p?p?=?0.039) and 2-year LPFS (85.7 vs. 59?%, p?=?0.119), RFS (38.1 vs. 7.3?%, p?=?0.063), and OS (83.3 vs. 44.3?%, p?=?0.037) rates than the LD group. Multivariate analysis showed that tumor response was significantly associated with OS.

Conclusion

SIB-IMRT is feasible and safe for patients with inoperable HCC.     

Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary Obstruction: Feasibility and Early Results

Purpose

Previous clinical studies have shown the safety and efficacy of this novel radiofrequency ablation catheter when used for endoscopic palliative procedures. We report a retrospective study with the results of first in man percutaneous intraductal radiofrequency ablation in patients with malignant biliary obstruction.

Methods

Thirty-nine patients with inoperable malignant biliary obstruction were included. These patients underwent intraductal biliary radiofrequency ablation of their malignant biliary strictures following external biliary decompression with an internal-external biliary drainage. Following ablation, they had a metal stent inserted.

Results

Following this intervention, there were no 30-day mortality, hemorrhage, bile duct perforation, bile leak, or pancreatitis. Of the 39 patients, 28 are alive and 10 patients are dead with a median survival of 89.5 (range 14–260) days and median stent patency of 84.5 (range 14–260) days. One patient was lost to follow-up. All but one patient had their stent patent at the time of last follow-up or death. One patient with stent blockage at 42 days postprocedure underwent percutaneous transhepatic drain insertion and restenting. Among the patients who are alive (n = 28) the median stent patency was 92 (range 14–260) days, whereas the patients who died (n = 10) had a median stent patency of 62.5 (range 38–210) days.

Conclusions

In this group of patients, it appears that this new approach is feasible and safe. Efficacy remains to be proven in future, randomized, prospective studies.     

Removal of the Antiscatter Grid During Routine Biliary Interventional Procedures Performed in a Flat-Panel Interventional Suite: Preliminary Data on Image Quality and Patient Radiation Exposure

Purpose

To determine whether grid removal during routine biliary interventional procedures performed in a flat-panel interventional suite results in adequate image quality and a significant decrease of patient radiation exposure.

Materials and Methods

Routine biliary interventional procedures were defined as those in which absence of fine image detail during fluoroscopy carries no procedural impact, including substitution of internal–external biliary drains (n = 25) or bilioplasty of benign biliary anastomotic strictures (n = 5). All patients had undergone a previous procedure in which the grid was used. Constant object-to-detector and source-to-image distance were maintained in each patient during the grid/no-grid procedures. The same fluoroscopy protocol was used for all examinations. The dose area product (DAP [cGy.cm²]) and procedure fluoroscopy time (seconds) were recorded for each procedure. DAP was normalized per unit of fluoroscopy time (nDAP [cGy.cm²/s]).

Results

In all procedures, image quality was considered adequate by two different interventional radiologists, and all procedures were successfully completed without significant changes in fluoroscopy time between the two groups (p = 0.13). In every procedure without the grid, nDAP was inferior compared with nDAP in procedures performed using the grid. The mean decrease in dose was 39.2 ± 23.5 % (p = 0.000001).

Conclusion

Our preliminary data show that removal of the grid during routine biliary procedures is feasible and results in a significant decrease of patient radiation exposure. This seems of particular relevance because most of these patients require frequent reintervention. Larger studies with more procedures are warranted to confirm these data.     

Tract Embolization With Gelatin Sponge Slurry for Prevention of Pneumothorax After Percutaneous Computed Tomography-Guided Lung Biopsy

Purpose

To determine the effect of embolization with absorbable gelatin sponge slurry on the incidence of pneumothorax (PTX) and need for chest tube placement after percutaneous lung biopsy.

Materials and Methods

Seven hundred fifty-two percutaneous lung biopsy procedures and fiducial seed placements were performed using computed tomography (CT)-guidance at a single institution. A retrospective review was performed including 145 patients with embolization (19.28 %) of the tract with gelatin sponge slurry during needle withdrawal and 607 patients who did not undergo tract embolization. Patient- and lesion-related characteristics were collected through the electronic health record and PACS. Outcome measures included the occurrence of PTX during or after the biopsy procedure and the need for chest tube placement. Analysis was performed by multivariate logistic regression.

Results

Although tract embolization did not significantly decrease the chances of developing PTX (p = 0.06), it did decrease the likelihood of progressing to requiring chest tube insertion. Without tract embolization, 10.7 % of cases required a chest tube, whereas only 6.9 % of the patients whose tract was embolized needed a chest tube (p = 0.01). A history of emphysema was associated with 151 % increased odds of PTX requiring chest tube placement after lung biopsy (p = 0.009). Tract length >24 mm was associated with a 262 % increase in the odds of requiring chest tube placement (p = 0.003).

Conclusion

Embolization of the needle tract during percutaneous lung biopsy with gelfoam slurry significantly decreased the odds of requiring a chest tube for PTX and should be considered for all patients, particularly those with emphysema and deep lesions.     

Ct-guided bone biopsy in cancer patients with suspected bone metastases: retrospective review of 308 procedures

Purpose

The authors assessed the adequacy and sensitivity of CT-guided bone biopsy in 308 procedures performed in 286 cancer patients with suspected bone metastases.

Materials and methods

An electronic search of our CT-guided bone biopsy database was retrospectively performed to evaluate the adequacy of samples and, in the event of negative samples, whether the patients had radiological progression at the site of biopsy (false negative). Adequacy and false-negative rate were compared with radiological features, biopsy location, specimen length and complications to assess any statistically relevant association with a multivariate logistic regression model.

Results

A total of 290/308 (94.1 %) samples were adequate. Forty-five patients had normal bone marrow and were followed-up, with evidence of progression at the site of biopsy in 10 cases (false-negative cases); overall sensitivity was 96.7 %. Specimen length was significantly correlated to the probability of an adequate biopsy (p = 0.035) and inversely correlated to the probability to obtain a false-negative result (p = 0.02). We encountered 11/308 (3.5 %) minor complications and no major complications.

Conclusion

CT-guided biopsy of bone lesions in cancer patients allows for a final diagnosis in 94 % of cases. A specimen longer than 1 cm may lead to a significant result in terms of adequacy and sensitivity. Negative biopsies with positive positron emission tomography or magnetic resonance imaging and specimen shorter than 1 cm should be repeated to avoid a false-negative result.     

Optimizing Needle Direction During Transjugular Liver Biopsy Provides Superior Biopsy Specimens

Purpose

Transjugular liver biopsy (TJLB) is commonly performed for staging of liver fibrosis and cirrhosis among patients with coagulopathy and/or ascites. We hypothesized that device orientation during needle firing influences hepatic tissue apposition with the specimen notch and specimen quality.

Methods

Needle biopsies were performed in ex vivo bovine livers with specimen notch of the biopsy device oriented at cranial, caudal, or lateral directions with respect to the guiding metal cannula. Biopsy specimen length was measured and evaluated for fragmentation using light microscopy. In addition, a consecutive cohort of patients (n = 50) who underwent TJLB with random (n = 22) or caudal (n = 28) needle orientation was retrospectively reviewed. The number of needle passes was documented, and pathology specimen adequacy was graded using an ordinal scale.

Results

A total of 400 biopsies were performed (100 in each orientation) in ex vivo bovine livers. Longer specimens were obtained with caudal orientation of the needle specimen notch (p < 0.0001, ANOVA and Kruskal–Wallis tests). There was no difference in the degree of fragmentation. In the retrospective clinical study, specimen adequacy was significantly higher among patients in the caudal orientation group (p = 0.0002, Mann–Whitney U test).

Conclusion

Caudal orientation of the needle specimen notch of the biopsy device during TJLB produces superior core biopsy specimens. This simple technical modification may assist in obtaining higher-quality biopsy specimens during TJLB.     

Quantitative evaluation of the pivot shift by image analysis using the iPad

Purpose

To enable comparison of test results, a widely available measurement system for the pivot shift test is needed. Simple image analysis of lateral knee joint translation is one such system that can be installed on a prevalent computer tablet (e.g. iPad). The purpose of this study was to test a novel iPad application to detect the pivot shift. It was hypothesized that the abnormal lateral translation in ACL deficient knees would be detected by the iPad application.

Methods

Thirty-four consecutive ACL deficient patients were tested. Three skin markers were attached on the following bony landmarks: (1) Gerdy’s tubercle, (2) fibular head and (3) lateral epicondyle. A standardized pivot shift test was performed under anaesthesia, while the lateral side of the knee joint was monitored. The recorded movie was processed by the iPad application to measure the lateral translation of the knee joint. Lateral translation was compared between knees with different pivot shift grades.

Results

Valid data sets were obtained in 20 (59 %) ACL deficient knees. The remaining 14 data sets were invalid because of failure to detect translation or detection of excessive translation. ACL deficient knees had larger lateral translation than the contra-lateral knees (p < 0.01). In the 20 valid data sets, which were graded as either grade 1 (n = 10) or grade 2 (n = 10), lateral translation was significantly larger in the grade 2 pivot shift (3.6 ± 1.2 mm) than the grade 1 pivot shift (2.7 ± 0.6 mm, p < 0.05).

Conclusion

Although some technical corrections, such as testing manoeuvre and recording procedure, are needed to improve the image data sampling using the iPad application, the potential of the iPad application to classify the pivot shift was demonstrated.

Level of evidence

Diagnostic study, Level III.     

Comparison of CT-Guided Percutaneous Biopsy with and Without Registration of Prior PET/CT Images to Diagnose Mediastinal Tumors

Purpose

To compare computed tomography (CT)-guided percutaneous biopsy with and without registration of prior positron emission tomography (PET)/CT images in the diagnosis of mediastinal tumors.

Methods

We performed clinically indicated percutaneous biopsy in 106 patients with mediastinal tumors in the anterior (n = 61), posterior (n = 21), middle (n = 16), and superior mediastinum (n = 8). The final diagnosis was based on surgical outcomes, or imaging findings and the results of at least 6-month follow-up. The patients underwent CT-guided percutaneous biopsy with (group 1, n = 56) or without (group 2, n = 50) registration of prior PET/CT images obtained no more than 22 days earlier. The registered images were used to plan the procedure and help target the tumors.

Results

CT-guided percutaneous needle biopsy yielded adequate samples in 101 of 106 (95 %) patients (group 1, n = 53; group 2, n = 48); in 95 patients (94 %), the diagnosis was confirmed by specific histological typing (group 1, n = 51; group 2, n = 44). The diagnostic accuracy of CT-guided percutaneous biopsy with and without the registration of prior PET/CT images was not statistically different (group 1, 96 %; group 2, 93 %, p = 0.324).

Conclusion

CT-guided percutaneous biopsy is an easy and safe procedure that can provide a precise diagnosis in the majority of mediastinal tumors. PET/CT-guided biopsy yielded no special diagnostic advantages.     

The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability

Purpose

We aimed to clarify whether the coronal alignment after medial unicompartmental knee arthroplasty (UKA) is predictable using preoperative full-length valgus stress radiography.

Methods

Thirty-seven consecutive patients with a mean age of 71.5 ± 7.0 years awaiting medial UKA were recruited. Full-length weight-bearing radiographs of the lower limbs were obtained pre- and postoperatively. Preoperative full-length valgus stress radiography in the supine position was also performed, and the transition of the hip-knee-ankle angle (HKAA) and the weight-bearing ratio were assessed. The tibia first cut technique was used, and the distal femur was cut parallel to the cutting surface of the proximal tibia during surgery.

Results

The mean postoperative HKAA was 2.0° ± 2.1° varus, and the mean weight-bearing ratio was 43.1 ± 7.7 %; each of these parameters demonstrated significantly strong correlations with the values on the preoperative valgus stress radiographs (p < 0.01), while the correlation between the postoperative alignment and the preoperative standing alignment without stress was moderate (p < 0.01). The postoperative alignment was slightly undercorrected compared to that observed on the valgus stress radiographs (p < 0.05), and no knees exhibited evident overcorrection compared to that on the valgus stress radiographs.

Conclusion

Preoperative valgus stress radiography is useful for evaluating the correctability of varus deformities and predicting the postoperative coronal alignment. For clinical relevance, performing preoperative valgus stress radiography would help to more precisely select patients and, when combined with the tibia first cut technique, aid in achieving the expected knee alignment and avoid severe undercorrection or overcorrection.

Level of evidence

Diagnostic study, Level II.     

Diagnostic performances of shear wave elastography: which parameter to use in differential diagnosis of solid breast masses?

Objective

To evaluate which shear wave elastography (SWE) parameter proves most accurate in the differential diagnosis of solid breast masses.

Methods

One hundred and fifty-six breast lesions in 139 consecutive women (mean age: 43.54?±?9.94 years, range 21–88 years), who had been scheduled for ultrasound-guided breast biopsy, were included. Conventional ultrasound and SWE were performed in all women before biopsy procedures. Ultrasound BI-RADS final assessment and SWE parameters were recorded. Diagnostic performance of each SWE parameter was calculated and compared with those obtained when applying cut-off values of previously published data. Performance of conventional ultrasound and ultrasound combined with each parameter was also compared.

Results

Of the 156 breast masses, 120 (76.9 %) were benign and 36 (23.1 %) malignant. Maximum stiffness (Emax) with a cut-off of 82.3 kPa had the highest area under the receiver operating characteristics curve (Az) value compared with other SWE parameters, 0.860 (sensitivity 88.9 %, specificity 77.5 %, accuracy 80.1 %). Az values of conventional ultrasound combined with each SWE parameter showed lower (but not significantly) values than with conventional ultrasound alone.

Conclusions

Maximum stiffness (82.3 kPa) provided the best diagnostic performance. However the overall diagnostic performance of ultrasound plus SWE was not significantly better than that of conventional ultrasound alone.

Key Points

? SWE offers new information over and above conventional breast ultrasound ? Various SWE parameters were explored regarding distinction between benign and malignant lesions ? An elasticity of 82.3 kPa appears optimal in differentiating solid breast masses ? However, ultrasound plus SWE was not significantly better than conventional ultrasound alone     

MR signal changes on hepatobiliary imaging after oral ingestion of manganese chloride tetrahydrate: preliminary examination

Purpose

To clarify magnetic resonance (MR) signal changes during hepatobiliary imaging after oral ingestion of manganese chloride tetrahydrate (Bothdel Oral Solution 10) (MCT).

Materials and methods

Subjects were an MCT phantom, 10 healthy volunteers and 155 consecutive patients. The phantom study evaluated the relationship between MCT concentration and MR signal intensity. The volunteer study qualitatively and quantitatively analyzed the time course of hepatobiliary imaging immediately and 30, 60, 120 and 180 min after oral ingestion of MCT. The clinical study analyzed the incidence and factors affecting signal changes on additional MRCP with MCT as a final scan during routine clinical MRCP.

Results

In the phantom study, a significant and excellent positive linear correlation was found between MCT concentration and R2* measurement (r ² = 0.996, p < 0.01). In the volunteer study, biliary imaging and hepatic R2* values changed significantly after oral ingestion of MCT (p < 0.05). In the clinical study, a signal drop on MRCP with MCT was visually confirmed in 14.8 % of cases. Multivariate logistic regression found no factors significantly affecting signal drop.

Conclusion

We recommend performing MRCP early after oral ingestion of MCT, because signal changes occur even during routine MRCP.     

Changes in conjunctival cytology and tear function tests with radioiodine treatment for hyperthyroidism

Objectives

Radioiodine (RAI) is used in the treatment of hyperthyroidism and differentiated thyroid cancer. Radioiodine therapy is associated with dry eyes and some side effects are seen especially due to beta rays. In this study, the functional and cytological status of lacrimal glands after RAI therapy was evaluated.

Methods

Twenty-five patients with a mean age of 55.16 years with planned low-dose RAI therapy were evaluated. Just before and 6 months after the treatment, the lacrimal glands were evaluated with tear break-up time (BUT), Schirmer’s test, impression cytology and “Ocular Surface Disease Index (OSDI)” questionnaire.

Results

The mean value of Schirmer’s test was 16.20 ± 3.61 pre-treatment and 11.28 ± 4.39 post-treatment for the right eye, and 15.76 ± 3.27 and 10.60 ± 4.42 for the left eye, respectively. The mean value of Schirmer’s test decreased significantly post-treatment in both eyes (p = 0.0001). The BUT score also decreased significantly post-treatment (p = 0.001). The mean value of OSDI score was 27.5 ± 8.02 pre-treatment and 46.36 ± 10.27 post-treatment. The mean value of OSDI score increased post-treatment (p = 0.0001). The impression scores also increased post-treatment in both eyes (p = 0.0001).

Conclusion

Even low-dose (≤30 mci) RAI treatment affects lacrimal gland functions. Low-dose RAI causes a decrease in the value of Schirmer’s test and the BUT test, and an increase in the value of OSDI score and impression scores.     

Percutaneous Image-Guided Cryoablation in Inoperable Extra-abdominal Desmoid Tumors: A Study of Tolerability and Efficacy

Objective

To determine the tolerability, effectiveness and outcomes of percutaneous image-guided cryoablation on inoperable extra-abdominal desmoid tumors.

Methods

Between 2011 and 2012, 13 patients (mean age 39.3 years, range 15–74) with inoperable extra-abdominal desmoid tumors were consecutively treated with cryoablation (17 tumors treated in 17 procedures), including two patients with Gardner syndrome and nine recurrences after surgery. Disease-free survival (DFS) and local control based on RECIST criteria were calculated on prospective clinical and imaging follow-up until 2013.

Results

Cryoablation was performed under ultrasound (n = 8), computed tomography (n = 1), or combined (n = 8) guidance, and under general (n = 15) or local (n = 2) anesthesia. A major complication was observed in one session (5.8 %). Mean follow-up was 11.3 months (6–27 months). Among all the patients treated, eight patients (47 %) presented residual tumors on the first magnetic resonance follow-up, which were asymptomatic. The DFS rate was stable at 82.3 % (95 % confidence interval 0.55–0.94) at 6, 12, and 24 months. The local tumor progression rate was 0 % at 6, 12, and 24 months. Two patients (12 %) presented an in situ recurrence.

Conclusions

Despite high rates of partial ablation, percutaneous image-guided cryoablation appears to be safe and effective for local control for patients with inoperable extra-abdominal desmoid tumors.     

Transperineal Prostate Core Needle Biopsy: A Comparison of Coaxial Versus Noncoaxial Method in a Randomised Trial

Purpose

To compare the procedural time and complication rate of coaxial technique with those of noncoaxial technique in transperineal prostate biopsy.

Materials and Methods

Transperineal prostate biopsy with coaxial (first group, n = 120) and noncoaxial (second group, n = 120) methods was performed randomly in 240 patients. The procedural time was recorded. The level of pain experienced during the procedure was assessed on a visual analogue scale (VAS), and the rate of complications was evaluated in comparison of the two methods.

Results

The procedural time was significantly shorter in the first group (p < 0.001). In the first group, pain occurred less frequently (p = 0.002), with a significantly lower VAS score being experienced (p < 0.002). No patient had post procedural fever. Haematuria (p = 0.029) and haemorrhage from the site of biopsy (p < 0.001) were seen less frequently in the first group. There was no significant difference in the rate of urethral haemorrhage between the two groups (p = 0.059). Urinary retention occurred less commonly in the first group (p = 0.029). No significant difference was seen in the rate of dysuria between the two groups (p = 0.078).

Conclusions

Transperineal prostate biopsy using a coaxial needle is a faster and less painful method with a lower rate of complications compared with conventional noncoaxial technique.